Minority Physicians Are Not Protected by Their White Coats

We applaud the authors’ work in their brief report “Implicit Bias Training in a Residency Program: Aiming for Enduring Effects,” and their work to address bias on a systemic level.1 A priority of the study was to provide insight into how biases perpetuate institutional inequities, exacerbate structural racism, and the significant damage this causes. We wish to add that minority resident physicians are not protected by their white coats. They are also subjected to bias and discrimination from staff, patients, attendings, and colleagues. This has a direct, negative impact on patient care.

In the article “Minority Resident Physicians’ Views on the Role of Race/Ethnicity in Their Training Experiences in the Workplace,” the authors capture the experiences of Black, Hispanic and Native-American residents. They describe daily microaggressions, indignities that communicate hostile, derogatory, or prejudicial slights and insults, throughout the entirety of their residency training. Underrepresented minority residents were the target of bias and discrimination not only in interactions with patients, but also from coresidents, attendings, program leadership and other health care team members. Despite clear recognition of discriminatory practices and behaviors toward patients and their own personal workplace experiences, residents expressed reluctance to formally report or even discuss such events due to perceived vulnerability.2 These unchecked incidents are very much present in health care systems and training programs alike, and are a factor in the perpetuation of health care disparities.

Similar to underrepresented minority faculty, minority residents may be reluctant to discuss these events due to concerns of creating friction amongst their colleagues, social and academic isolation, loss of important opportunities, or even retaliation for speaking up.4 Recurrent exposure to discrimination contributes to emotional exhaustion, depression, and suicidal ideation, and can lead to total abandonment of one’s position and profession.2-5 As physicians of color care for 53.5% of minority patients and 70.4% of non-English speaking patients,6 this affects the diversity and inclusion of the current and future physician workforce and wholly compromises health care outcomes, especially for traditionally disadvantaged groups. Measures and safeguards must be implemented to address the daily micro- and macroaggressions underrepresented minority residents endure within the larger framework of reducing systemic bias to thwart lasting negative effects.

People of color suffer from pervasive discrimination and deeply ingrained systemic issues that result in disparate outcomes. Minority resident physicians are not protected by their white coats, and unchecked biased behaviors toward them directly impacts patient care. Medical professionals of every color, and in every sphere must endeavor to consistently denounce and dismantle everything resembling prejudice for both our patients and our underrepresented minority residents to thrive.